title: Hepatic resection for hepatocellular carcinoma patients on hemodialysis for uremia: a nationwide cohort study.
abstract: BACKGROUND
  The association between uremia and survival outcomes of patients undergoing hepatic resection for hepatocellular carcinoma (HCC) has not been well investigated, particularly for perioperative complications. This nationwide cohort study aimed to compare survival outcomes as well as perioperative mortality and complications between uremia-HCC patients and non-uremia-HCC patients who underwent hepatic resection.
  
  
  METHODS
  Using Taiwan's National Health Institute Research Database, 149 uremia-HCC patients who underwent hepatic resection between 1996 and 2008 were enrolled. The control group comprised 596 HCC patients who also received hepatic resection during the same time period. The two groups were matched for age, gender, viral hepatitis status, and underlying liver cirrhosis. Disease-free survival, overall survival, and perioperative complications were compared between the two groups.
  
  
  RESULTS
  For the uremia-HCC cohort, the 1-, 5-, and 10-year overall and disease-free survival rates were 86, 52, and 38 %, as well as 77, 27, and 18 %, respectively. The survival outcomes were comparable between uremia-HCC cohort and the HCC cohort, regardless of extent of hepatic resection. As for perioperative complications, the uremia-HCC cohort had a higher risk of postoperative infections requiring invasive interventions as well as an increased risk of life-threatening heart-associated complications, compared to the HCC cohort.
  
  
  CONCLUSIONS
  Uremia did not influence survival outcomes between the uremia-HCC and the HCC cohorts, irrespective of extent of hepatic resection. This study urges a better perioperative care strategy to avoid potential cardiac and infectious complications in uremia-HCC patients.
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan. b8202034@gmail.com
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Yeh
authors.forename: Jaw-Town
authors.initials: JT
authors.lastname: Lin
authors.forename: Long-Bin
authors.initials: LB
authors.lastname: Jeng
authors.forename: Iakovidis
authors.initials: I
authors.lastname: Charalampos
authors.forename: Tzu-Ting
authors.initials: TT
authors.lastname: Chen
authors.forename: Teng-Yu
authors.initials: TY
authors.lastname: Lee
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
authors.forename: Ken N
authors.initials: KN
authors.lastname: Kuo
authors.forename: Yi-Ya
authors.initials: YY
authors.lastname: Liu
authors.forename: Chun-Ying
authors.initials: CY
authors.lastname: Wu
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D006435:Renal Dialysis; D012307:Risk Factors; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome; D014511:Uremia / Q000209:etiology / Q000628:therapy*